Acta neurochirurgica
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Acta neurochirurgica · Jan 1999
Comparative StudyThe prognostic importance of the volume of traumatic epidural and subdural haematomas revisited.
The size of a traumatic intracranial haematoma at the moment of diagnosis can be impressive. Haematoma thickness is an inaccurate estimator of haematoma volume, and association with patient outcome is controversial. In this study computerized volumetry of offline digitized CT scans was used to relate haematoma volume with both patient characteristics on admission and at the six months outcome. ⋯ Ninety eight patients operated upon for an epidural haematoma and 91 patients operated upon for an acute subdural haematoma were analyzed. The relative importance of clinical data, CT scan parameters, and calculated haematoma volumes was determined by multivariate analysis. Volume of the haematoma did not correlate with preoperative neurological condition or the six months outcome in either group, and consequently is not of additional prognostic value.
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Acta neurochirurgica · Jan 1999
Clinical TrialVagus nerve stimulation for medically refractory epilepsy; efficacy and cost-benefit analysis.
Vagus nerve stimulation is a novel treatment for patients with medically refractory epilepsy, who are not candidates for conventional epilepsy surgery, or who have had such surgery without optimal outcome. To date only studies with relatively short follow-up are available. In these studies efficacy increased with time and reached a maximum after a period of 6 to 12 months. Implantation of a vagus nerve stimulator requires an important financial investment but a cost-benefit analysis has not been published. ⋯ VNS is an effective treatment of refractory epilepsy and remains effective during long-term follow-up. Cost-benefit analysis suggests that the cost of VNS is saved within two years following implantation.
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Acta neurochirurgica · Jan 1999
Transcranial Doppler-determined pulsatility index in the evaluation of endoscopic third ventriculostomy (preliminary data).
Endoscopic 3rd ventriculostomy has become the method of choice in the management of occlusive hydrocephalus. The treatment is accompanied by significantly less peri-operative complications than the cerebrospinal fluid shunting procedures previously employed. Close surveillance of patients, however, is necessary to avoid the consequences of raised intracranial pressure that may develop in case of obstruction of the artificial outlet of the 3rd ventricle. The aim of this study was to confirm the value of transcranial Doppler-determined pulsatility index (PI) in the assessment of the patency of endoscopic 3rd ventriculostomy and to elucidate its usefulness in early postoperative recognition of increased intracranial pressure. ⋯ Preliminary results suggest that the transcranial Doppler-determined pulsatility index is a useful non-invasive tool for the evaluation of the patency of the fenestration in the early follow-up of patients who underwent endoscopic third ventriculostomy.
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Acta neurochirurgica · Jan 1999
Comparative Study Clinical TrialBurr hole evacuation of chronic subdural haematomas followed by continuous inflow and outflow irrigation.
Chronic subdural haematomas are prone to recollect, increasing the risk of further complications and death. Burr hole evacuation followed by continuous irrigation of a Ringer solution into the remaining subdural cavity, allows remaining blood to be washed out and the brain to re-expand. This technique was compared with burr hole evacuation either without or with a passive drainage and craniotomy, respectively. ⋯ Recurrent haematomas evacuated through a craniotomy had no complications from infections. Compared to other methods, continuous irrigation reduces the need for re-operation significantly by preventing haematoma recurrence and empyema formation. Contrary to other surgical techniques, haematoma recurrence after second time surgery did not occur.
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Acta neurochirurgica · Jan 1999
Long-term functional effects of aneurysmal subarachnoid haemorrhage with special emphasis on the patient's view.
Although physical and emotional dysfunction appears to be quite frequent even among independent survivors of aneurysmal subarachnoid haemorrhage (SAH), these symptoms may easily be missed on routine follow-up examinations. To assess the long-term functional effects of SAH and to outline possible treatment approaches, a cross-sectional study using multidimensional measures of relevant areas of function was performed on 40 independent survivors. After an average follow-up period of 22 months, patients were selected and enrolled following a pre-designed protocol. ⋯ Mild to moderate depression was underdiagnosed, although such an emotional dysfunction influences working capacity and quality of life. Referral to rehabilitation centers appears to be restricted to patients with severe impairments. Our results help to alert the neurosurgeon to these possible symptoms and show the urgent need for a prospective, interdisciplinary and multidimensional follow-up of SAH survivors.